Schizophrenia is an incredible example of mental muddle which is exemplified by crumbling of thought processes and emotional receptiveness. It can be straightforwardly acknowledged by auditory hallucinations, paranoid or bizarre illusions, dislocated speech or thinking aptitude pursued by social or occupational dysfunction. The warning signs initiate untimely in the adulthood. The disease is recognized to affect about 1% of the human population with about 2 million patients from the United States unaided.
Schizophrenia is also known as split personality disorder and it affects men extra recurrently in contrast to women. A number of aspects play decisive task in aggravating the symptoms of this disorder and these issues are genetic parameters, early environment, neurobiology, physiological and social processes. Some drugs also contribute a petite portion in making the condition of the patient poorer.
In the present scenario researchers are very much spotlighted on the neurobiological factors but no apposite consequence has cropped up. The authentic cause of the disorder is still a contentious concern and the intact argument is centered on the verity that whether the disorder is due to a single cause or other syndromes are also correlated with it. The word schizophrenia has been taken from a Greek word implicating split mind. Antipsychotic medication is usually applied while treating the patients of this disorder as it curbs dopamine and serotonin receptor bustle. Psychotherapy tracked by social and vocational rehabilitation play an imperative role in treatment. In very ruthless cases hospitalization becomes obligatory. The disorder is essentially branded to influence cognition causing setbacks connected with behavior and emotions. Patients also suffer from depression and anxiety disorders. The typical life span of the patient is of 12-15 years after the identification of the disease.
The ICD-10 criteria are used in the European countries but DSM-IV-TR criteria are used in the United States and rest of the world for the classification of schizophrenia. The ICD-10 criteria accentuate more on Schneiderian first-rank symptoms. The revised fourth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) defines three major criteria while classifying individuals suffering from schizophrenia. Individuals suffering from this disease generally suffer from delusions, hallucinations, disorganized speech, grossly disorganized behavior and negative symptoms. The personal relations as well as the personal life of the victim also get distracted. These signs of disturbance generally persist for about six months. Children belonging to the age group of 6 years sometimes show symptoms of this disease and they are at the risk of developing these symptoms more intensely in their adulthood. There are five types of schizophrenia each can be distinguished on the basis of the symptoms. These are:
1. Paranoid Schizophrenia
In this case the victim suffers from one or more different types of delusions as well as auditory hallucinations. The symptoms of this type are entirely different from that of disorganized schizophrenia.
2. Disorganized Schizophrenia
The most noticeable symptoms of the disorganized schizophrenia are disorganized speech and behavior but the symptoms are absolutely different from that of catatonic schizophrenia.
3. Catatonic Schizophrenia
The persons suffering from this disorder generally feel difficulty in moving, show resistance in moving as well as show anomalous movements also.
4. Undifferentiated Schizophrenia
This condition can be identified by delusions, hallucinations, disorganized speech or behavior, catatonic behavior or negative symptoms. The individuals suffering from this state cannot be placed in the category of paranoid, disorganized and catatonic schizophrenia.
5. Residual Schizophrenia
The common symptoms include difficulty in speaking as well as loss of interest in daily activities.
The term schizophrenia is in practice since 1911. It was finally kept in the category of mental illness in 1887 by Emil Kraepelin. The Ancient Egyptian, Hindu, Chinese, Greek, and Roman writings also describe about this disorder. During the medieval times schizophrenia was thought to be caused by spirits and evil powers. Studies have specified that the social stigma is one of the treacherous obstacles that stop the patients of schizophrenia from recovering. A study carried out in 1999 designated that about 12.8% Americans who were suffering from schizophrenia were more interested violent activities while 48% individuals were calm and quite. A very famous Hollywood film entitled The Beautiful Mind depicts the life of John Nash who suffers from paranoid schizophrenia. Another film The Soloist portrays about the challenges faced by Juilliard-trained musician Nathaniel Ayers as a result of schizophrenia.
Both genetic as well as environmental factors play a strategic role in the development of schizophrenia. People with family history of the disease are at the risk of getting distressed with the disease in near future. However, the guesstimates of heritability vary due to difficulty in separating the genetic as well as environmental factors while identifying the disease. According to an estimate about 40% of the mono-zygotic twins are at the risk of getting infected with this disease. Many genes are associated with development of every symptom of the disorder. A number of genome wide associations like zinc finger protein 804A, NOTCH4 and protein loci are found to be linked. There appears a momentous overlap between the genetics of schizophrenia and bipolar disorder. The environmental factors that are linked with schizophrenia include living environment, prenatal stressors and drug intake. Social isolation and immigration related to social adversity, racial discrimination, family dysfunction, unemployment, and poor housing conditions also play a crucial role in the development of this disorder. Childhood factors like sexual abuse and any trauma can result in schizophrenia in the adulthood.
A number of drugs namely cocaine, cannabis and amphetamines also contribute in the development of schizophrenia. Individuals suffering from schizophrenia normally consume drugs in order to cope up with depression, loneliness, boredom and anxiety. Cannabis is generally associated with increasing the risk of development of a psychotic disorder. Frequent use of this drug generally doubles the risk of getting affected with schizophrenia and psychosis. Excessive intake of cocaine and amphetamine can also increase the risk of schizophrenia. Other factors like hypoxia and infection, stress or malnutrition in the mother during fetal development can somewhat increase the risk of schizophrenia in the baby in later stages of life. Studies have indicated that the people suffering from schizophrenia are generally born in the months of winter and spring and are at the risk of getting infected with viral diseases more frequently. The percentage of such individuals varies from 5-8%.
Signs and Symptoms
An individual diagnosed with schizophrenia may complain of hallucinations, delusions, disorganized thinking and speech. Disorganized speech includes loss of ability to speak clear sentences. Social withdrawal, sloppiness of dressing and hygiene, loss of motivation and judgment power are common in schizophrenia. Loss of responsiveness and impairment in social cognition are very common in this disorder. Social isolation is the symptom of paranoia. The person may become mute, may show purposeless agitation showing signs of catatonia. Late adolescence and early adulthood are the peak periods at which an individual is at higher risk of getting affected with schizophrenia. Data have shown that in 40% of men and 23% of women the symptoms of schizophrenia generally arise at the age of 19.
Positive and negative symptoms of Schizophrenia
Schizophrenia is often defined in terms of positive and negative symptoms. The positive symptoms of the disease are normally not experienced by the victim but are present within the body of the patient and may remain unnoticed. These symptoms comprise tactile, auditory, gustatory, visual and olfactory hallucinations that are typically regarded as expressions of psychosis. Delusions and disordered thoughts and speech are other symptoms. These positive symptoms can be well treated with medication. The negative symptoms include loss of normal emotional responses or other thought responses and are difficult to be treated with medication. The other negative symptoms include blunted affect and emotion, poverty of speech, the desire to form relationships is lost, lack of motivation and inability to experience pleasure. The negative symptoms worsen the life of the victim and are a burden on the patient.
Mechanisms associated with schizophrenia
A number of studies have been carried out to find out the link between altered brain function and schizophrenia. The most commonly agreed hypothesis is the dopamine hypothesis which emphasizes that schizophrenia is the result of misfiring of the dopaminergic neurons. A number of psychological interpretations are also thought be responsible for the development of this disorder. Cognitive biases have been identified exclusively in the conditions of confusion and stress. Some cognitive features may lead to memory loss. Recent studies have indicated that the patients of schizophrenia are emotionally responsive to stressful conditions as well as to negative stimuli and such symptoms may worsen the state of the victim. Delusional beliefs and psychotic experiences may also make the condition of the patient poor.
The diagnosis of schizophrenia indicates changes in both brain structure and brain chemistry. Studies using the neurophysiological tests and brain imaging techniques like fMRI and PET have shown functional changes in the brain activity especially of the frontal lobes, temporal lobes and hippocampus. Changes in the brain volume particularly of the frontal cortex and the temporal lobes have been noticed. Since the neural circuits are altered, schizophrenia is sometimes considered as a collection of neuro-developmental disorders. While dealing with the mechanism of this disorder much consideration is given to the function of dopamine in the meso-limbic pathway of brain. This focus has largely resulted from the accidental finding that the phenothiazine drugs bear the potential of blocking the dopamine function so can help to diminish the psychotic symptoms. It is also supported by the fact that amphetamines which trigger dopamine release can intensify psychotic symptoms. The dopamine hypothesis points out that excessive release of the D2 receptors are the actual cause of schizophrenia.
In the present scenario much focus is centered on the neurotransmitter glutamate and reduced function of NMDA glutamate receptor in schizophrenia. The post-mortem of brains of patients of schizophrenia has shown abnormally low levels of glutamate receptors and glutamate blocking drugs can enhance cognitive problems. Reduction in the activity of glutamate can also affect the activity of frontal lobes and the hippocampus. Dopamine function is also known to be affected due to reduction in glutamate activity. Positive symptoms however, fail to respond to the glutamatergic medication.
At present there is no definite test available that can assure that a particular person is suffering from schizophrenia. The health practitioners gather information from the medical, family and medical-health backgrounds in order to diagnose this disorder. The practitioner can also perform some sort of physical tests in order to check the symptoms of this disorder. The medical examination includes some lab tests in order to get an idea of the patient’s health. Mental health professionals deal with the symptoms like hallucinations, delusions, depression, anxiety or physical abuse. Some symptoms of schizophrenia can also occur in other disorders like the bipolar disorder, anxiety disorder and personality disorder. Any disorder associated with abnormal behavior, mood or thinking for example borderline personality disorder or dissociative identity disorder (DID) commonly known as multiple personality disorder (MPD) are generally difficult to be distinguished from schizophrenia. The mental-health professionals can also perform mental test examinations. Patients of schizophrenia are at elevated risk of getting affected with anxiety or depression disorder and of committing suicide.
A number of treatments are yet available but medication plays a key role in treating schizophrenia. These medications are known as anti-psychotics as they reduce the intensity of the psychotic symptoms. Many health care professionals prescribe a combined dose of these medications along with the psychiatric drugs in order to provide benefit to the patient. Medications that are beneficial in dealing with the positive symptoms of this disorder are olanzapine, risperidone, quetiapine, paliperidone and asinapine. These drugs are also known as second generation anti-psychotics. These drugs act faster in comparison to the psychiatric medications. These anti-psychotic drugs also suffer from some side effects including dizziness, sleepiness and increased appetite. Weight gain, high blood sugar levels, increased blood lipid levels and sometimes higher level of prolactin hormone have been noticed. The medications that are useful in treating the symptoms of schizophrenia may not be equally effective in treating the symptoms of the disorder in childhood.
Mood stabilizer medications like lithium, carbamazepine and lamotrigine can be used to deal with mood fluctuations in addition to psychotic symptoms. These medications take a longer time to show their effect in addition to the anti-psychotic drugs. These drugs can cause birth defects if taken by pregnant women. Antidepressant medications can be taken in order to deal with depression in schizophrenia. The common antidepressants are serotonergic medications that affect the serotonin levels and the common examples are fluoxetine, paroxetine, citalopram and duloxetine. Electroconvulsive therapy (ECT) is a better option for the patients who show inadequate result while treating with medication trials as well as psychosocial interventions. While dealing with pregnant women with schizophrenia the health professions become more cautious and take extra care of the patient. Some medications can increase the risk of damage to fetus and during breast feeding so the health professionals try to overcome these factors.
Educating the family members about the symptoms, course and treatment of schizophrenia comes under the category of psycho-education. This tool includes family support, problem solving skills and help from care-providers at the time of crisis. This intervention has given better results if continued for several months as it decreases the problems associated with emotional and social stresses. The burden over the family members is also reduced as with the help of health experts the family relationship of the patient also improves. Assertive community treatment (ACT) is another intervention which consists of meeting of the health experts with the patient in community settings rather than home or home. The team of health professionals is made up of a variety of experts for example, a psychiatrist, nurse, case manager, employment counselor and substance abused counselor. This tool is helpful in the treatment of patients who are either hospitalized or become homeless. Medical and psychosocial interventions focusing on substance abuse are integral part of treatment that specifically deals with the patients of schizophrenia. According to an estimate about 50% patients of schizophrenia suffer from some kind of substance abuse or dependence.
Social skill training is another important tool that teaches e important skills to the patients so that they can handle social situations easily. This treatment is helpful for the patients that resist using drugs. Supported employment provides support like a work coach, interviewing for jobs and education and support for the employers to hire individuals with chronic medical illness. This treatment helps the patients to work for prolong hours. Cognitive behavioral therapy is a reality based intervention that helps a client to deal with all the problems that interfere with his or her ability to interact with others. This tool helps to improve social relationships of the individual. This intervention can be performed individually or in group sessions. By educating the patients about the side effects of the anti-psychotic drugs the body weight of the patient can be managed.
According to a report presented in 2011 about 24 million people are suffering from schizophrenia. This disorder occurs 1.4 times more frequently in males as compared to that in females. The peak ages for the onset of symptoms of the disorder are 20-28 years for males and 26-32 for females. The onset of the symptoms of the disorder is generally rare in childhood but may arise in later stages. The percentage of occurrence of schizophrenia varies in different nations. The patients are at a double risk of death than the normal individuals. Almost half of the patients suffer from substance abuse during their lifetime.
Cognitive remediation is in use now-a-days as it helps the individuals with schizophrenia to deal with the cognitive problems. Vocational rehabilitation deals with increasing the efficiency of the patient to deal with social situations. Peer-to-peer treatment is a promising intervention as it helps the individuals of schizophrenia to develop constructive involvement. More research is required to deal with the weight management problems.